Find all the open medical aid plans here. Compare any two plans side by side, instantly.
In-hospital Procedures for 2022:
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated
|
non-Network Specialists: |
|
network Specialists: |
|
non-Network GPs: |
|
network GPs: |
|
Hospital Choice: |
|
|
Day Hospitals: |
- No specific requirements for day hospital use are listed
|
|
Penalty for using other hospital: |
|
Other Co-payments: |
- Gastroscopy: R2,800 co-payment
- Colonoscopy: R2,800 co-payment
- Cystoscopy: R2,800 co-payment
- Nasal or sinus endoscopy: R2,600 co-payment
- Functional nasal surgery and septoplasty: R2,600 co-payment
- Hysteroscopy: R2,600 co-payment
- Flexible sigmoidoscopy: R2,600 co-payment
- Arthroscopy: R2,600 co-payment
- Minor gynaecological laparoscopic procedure: R2,600 co-payment
- Dental: R2,600 co-payment
- Excision lesion- benign and malignant: R2,600 co-payment
- Joint replacements- arthroplasty: R2,000 co-payment
- Conservative back and neck treatment- spinal cord injections: R2,000 co-payment
- Laminectomy and spinal fusion: R2,600 co-payment
- Nissen fundoplication- reflux surgery: R2,600 co-payment
- Hysterectomy, except for cancer: R2,600 co-payment
- Laparoscopic hemi colectomy: R2,600 co-payment
- Laparoscopic inguinal hernia repair: R2,600 co-payment
- Laparoscopic appendectomy: R2,600 co-payment
- Annual Limit for the above procedures: R43,000
|
Specialised Radiology: |
- MRI, CT and PET Scans: Unlimited
- R2,250 co-payment, unless PMB
- No benefit for screening purposes
- In and out of hospital
|
Supplementary Services: (Physio, etc) |
- Speech therapists, social workers, podiatrists, occupational therapists, homeopaths and naturopaths, dietitians, chiropractors (X-rays excluded), audiologist, physiotherapy and biokinetics in-and-out of hospital:
R7,500 per family from day to day benefit
|
Transplants: |
|
|
Dialysis: |
|
|
Exclusions: |
|
Alternatives to hospitals: |
- Home nursing: 40 days per family
- Step-down nursing, hospice and rehab: as authorised
|
|
Casualty: |
- One visit per child under 6 yrs: R1 300 paid by scheme
|
Other: |
- Surgical procedures out of hospital: Unlimited
- Treatment for injuries due to extreme sports are covered
- Internal nerve stimulators:R120,000
|
|
Note: |
- PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
- DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
- Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
|
♦️View all the other benefits for this plan:♦️
Inhospital |
Out of hospital |
Medication |
Maternity |
Cancer |
Mental Health |
Dentistry |
Optometry |
Other/Extra Benefits |
Wellness |
Prosthetics
You can also:
♦️Compare any two plans, side by side |
♦️View all the Compcare plans, with costs and brief summary
|
. |
Out-of-hospital Procedures for 2022:
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated |
|
Main Member: |
Adult: |
Child: |
|
|
|
|
|
|
|
|
|
- Main= R9,200
- Main+1= R16,380
|
|
- All medical aids must pay for the diagnosis, treatment and management of all PMB conditions, in or out of hospital. You can see a full list of the conditions here.
- This can include consults with specialists, blood or other tests, radiology and medicine
- The benefit is paid by the scheme, and not out of your savings account
- If you have no day-to-day funds, you still have cover for PMBs
- Schemes usually impose the use of specific providers for treatment of PMBs. Read more about that here.
- See our Guide to PMBs for more information.
|
Claims are first paid Savings Account, then from Fund (AFB). When this is finished, member pays self-payment gap out of pocket. During this period, claims will accumulate to the annual threshold at the scheme rate. Once the annual threshold is reached, specific Above Threshold Benefits (ATB) will be available up to a limit of R8,280 per person and R14,676 per family
|
- From day-to-day benefit
- One wellness consult, excluding procedures, paid by scheme
- Unlimited GP consultations and basic dentistry for children under 6yrs, paid by scheme
|
- Baby Wellness consults: 2 per year, for 4m-18m
- Unlimited GP consultations and basic dentistry for children under 6yrs
- Initial Occupational Therapy consultation
- School readiness assessments
- Kid’s active benefit assessment and exercise prescription
programme
- Kid’s nutritional benefit assessment and healthy eating programme
|
|
- From day-to-day benefits, with a 30% co-payment if not referred by GP
- Sublimit of R4,500 per family from above threshold benefit
|
- From day-to-day benefits
- R3,500 per family limit from threshold benefit, combined with radiology
|
- From day-to-day benefits
- R3,500 per family limit from threshold benefit, combined with radiology
|
- MRI, CT and PET Scans: Unlimited
- R2,250 co-payment
- No benefit for screening purposes
- In and out of hospital
|
- Speech therapists, social workers, podiatrists, occupational therapists, homeopaths and naturopaths, dietitians, chiropractors (X-rays excluded), audiologist, physiotherapy and biokinetics in-and-out of hospital:
R7,500 per family from day to day benefit
|
|
- R17,900, from day-to-day benefit
|
- R17,700, from day-to-day benefit, every 3 years
|
- R4,600, from above Appliance limit
|
- PMBs: Prescribed Minimum Benefits. To read more about PMBs click here
- DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
- Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
|
♦️View all the other benefits for this plan:♦️
Inhospital |
Out of hospital |
Medication |
Maternity |
Cancer |
Mental Health |
Dentistry |
Optometry |
Other/Extra Benefits |
Wellness |
Prosthetics
You can also:
♦️Compare any two plans, side by side |
♦️View all the Compcare plans, with costs and brief summary
|
. |
All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.
Medication Benefit for 2022:
(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)
Assume scheme pays all these costs, unless otherwise stated |
|
Main Member: |
Adult: |
Child: |
|
|
|
|
|
|
|
|
|
- Main= R9,200
- Main+1= R16,380
|
|
Chronic: |
- Additional 38 conditions: from day-to-day benefit, up to R10,000 per person and R17,000 per family
- Above threshold benefit is limited to R3,500 per family
|
- From day-to-day benefit
- R3,350 per family, when in threshold
|
|
- R220 per script
- No sublimit in savings
- R1,000 per person and R1,450 per family
- Does not accumulate to threshold
|
- R2,950 per person, including devices
|
|
- R230,000 per family, with 25% co-payment
|
- Schemes have very strict rules about where you can get your medicine to get full benefit. We do not list the requirements here, so confirm with your scheme before you collect your medicine.
- Formulary: A pre-defined list of approved medicines. Each plan has a different list, and might not pay for non-listed medicine. Confirm with your scheme whether your required medicine is covered by them.
- PMBs: Prescribed Minimum Benfits. To read more about PMBs click here
- DSPs: Designated Service Provders. Where stipulated, you must use specific specific providers to get full benefit.
- Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product
|
♦️View all the other benefits for this plan:♦️
Inhospital |
Out of hospital |
Medication |
Maternity |
Cancer |
Mental Health |
Dentistry |
Optometry |
Other/Extra Benefits |
Wellness |
Prosthetics
You can also:
♦️Compare any two plans, side by side |
♦️View all the Compcare plans, with costs and brief summary
|
. |
All benefits, including gap benefits, are subject to treatments and procedures being authorised by medical scheme. The benefits listed here are an indication only. Please verify all benefits and their conditions with the scheme.
|